ABSTRACT
Microalbuminuria (MA) is a known marker for endothelial dysfunction and future cardiovascular events. Exercise-induced albuminuria (EiA) may precede the appearance of MA. Associations between EiA and metabolic syndrome (MS) have not been assessed so far. Our aim was to investigate this association in a large sample of apparently healthy individuals with no baseline albuminuria. This was a cross-sectional study of 2,027 adults with no overt cardiovascular diseases who took part in a health survey program and had no baseline MA. Diagnosis of MS was based on harmonized criteria. All patients underwent an exercise test (Bruce protocol), and urinary albumin was measured before and after the examination. Urinary albumin-to-creatinine ratio (ACR) values before and after exercise were 0.40 (0.21-0.89) and 1.06 (0.43-2.69) mg/g for median (interquartile range) respectively. A total of 394 (20%) subjects had EiA; ACR rose from normal rest values (0.79 mg/g) to 52.28 mg/g after exercise (P < 0.001); this effect was not shown for the rest of the study population. EiA was related to higher prevalence of MS (13.8% vs. 27.1%, P < 0.001), higher metabolic equivalents (P < 0.001), higher baseline blood pressure (P < 0.001), and higher levels of fasting plasma glucose, triglycerides, and body mass index (P < 0.001). Multivariate binary logistic regression model showed that subjects with MS were 98% more likely to have EiA (95% confidence interval: 1.13-3.46, P = 0.016). In conclusion, EiA in the absence of baseline MA is independently related to MS.
Subject(s)
Albuminuria/physiopathology , Exercise/physiology , Metabolic Syndrome/physiopathology , Adult , Albuminuria/complications , Albuminuria/urine , Creatinine/urine , Cross-Sectional Studies , Exercise Test , Female , Humans , Male , Metabolic Syndrome/complications , Metabolic Syndrome/urine , Middle AgedABSTRACT
BACKGROUND AND OBJECTIVE: The present study, using a decision analysis, evaluates whether an exercise tolerance test (ETT) is indicated before initiating regular physical activity to reduce the risk of sudden death during exercise training. DESIGN: The study encompasses a decision tree, Monte Carlo simulation, and utility analysis for adults at low to high risk for coronary disease, with a time horizon of five years, with or without routine ETT screening before initiating physical activity. MEASURES: Mortality in Monte Carlo simulation; expected values in utility analysis. RESULTS: Routine screening decreases mortality in intermediate to high-risk populations but not in low-risk persons. At all risk levels, the number of exercise-induced deaths prevented is less than the added number of deaths from angiography. Utility analysis indicates inferiority of routine screening, regardless of risk. Personal preferences (perceived stigma from having coronary disease and perceived benefit of regular exercise on quality of life) have a strong influence on the optimal choice. CONCLUSION: Routine screening before initiating regular exercise is not recommended for the purpose of reducing the risk of sudden death during exercise training.